Justia Insurance Law Opinion Summaries

The business-owners liability insurance policy in this case did not provide coverage for a negligent supervision claim arising out of an alleged employee’s intentional act of physically punching a customer in the face.The circuit court granted summary judgment in favor of the Insurer, concluding that there was no coverage under the policy for either the employee’s intentional act or the negligent supervision claim against the employer arising out of the employee’s intentional act. The court of appeals reversed. The Supreme Court reversed, holding that where the negligent supervision claim pled rested solely on the employee’s intentional and unlawful act without any separate bais for a negligence claim against the employer, no coverage existed. View "Talley v. Mustafa" on Justia Law

An insured plaintiff who has chosen to be treated with doctors and medical facility providers outside his insurance plan shall be considered uninsured, as opposed to insured, for the purpose of determining economic damages. The Court of Appeal held that the trial court properly allowed the plaintiff in this case, as a plaintiff who is treating outside his insurance plan, to introduce evidence of his medical bills. The trial court also permitted defendants to present expert testimony that the reasonable and customary value of the services provided by the various medical facilities was substantially less than the amounts actually billed. The jury rejected the expert evidence and awarded plaintiff the billed amounts. The court held that defendants have not demonstrated error except with respect to two charges regarding the amounts billed by Ventura County Medical Center and American Medical Response. Accordingly, the court reduced the damage award and affirmed the judgment as modified. View "Pebley v. Santa Clara Organics" on Justia Law

Plaintiffs Candice Reis and Melvin Williams appealed the grant of summary judgment to defendant OOIDA Risk Retention Group, Inc. (“OOIDA”) in a direct action against OOIDA and others arising from a vehicular collision involving Plaintiffs and a motor carrier insured by OOIDA. At issue was whether provisions in the federal Liability Risk Retention Act of 1986 (“the LRRA”), 15 USC 3901, et seq., preempted Georgia’s motor carrier and insurance carrier direct action statutes, OCGA sections 40-1-112 (c),1 40-2-140 (d) (4), in regard to risk retention groups, thereby precluding this direct action against OOIDA. After review of the statutes at issue here, the Georgia Supreme Court concluded there was indeed federal preemption of this action against OOIDA, and consequently, affirmed summary judgment. View "Reis et al. v. OOIDA Risk Retention Group, Inc. et al." on Justia Law

The three-year statute of limitations set forth in N.Y. C.P.L.R. 214(2) applies to no-fault claims against a self-insurer.Girtha Butler sustained personal injuries in a motor vehicle accident involving a New York City Transit Authority (Defendant) bus in which she was a passenger. Plaintiff provided health services to Butler for her injuries, and Butler assigned to Plaintiff her right to recover first-party benefits from Defendant, who was self-insured. Plaintiff then brought this action seeking reimbursement for allegedly outstanding invoices it had submitted to Defendant. Defendant moved to dismiss the complaint based on Plaintiff’s failure to bring the action within the three-year statute of limitations under N.Y. C.P.L.R. 214(2). Civil Court denied the motion, ruling that the six-year statute of limitations set forth in N.Y. C.P.L.R. 213(2) controlled this case. The Court of Appeals reversed, holding that the three-year period of limitations in N.Y. C.P.L.R. 214(2) should control this case. View "Contact Chiropractic, P.C. v. New York City Transit Authority" on Justia Law

The Court of Appeal reversed the trial court's entry of judgment for Gursey in an action alleging that plaintiffs had been damaged because they could not collect the additional money they would have been entitled to had Gursey purchased an insurance policy with the limits they had requested. The court held that plaintiffs did not incur actual damages until they became entitled to the benefits of the underinsured motorist policy. Consequently, plaintiffs' causes of action against Gursey accrued less than two years before they filed this action, and the trial court erred in holding that plaintiffs' claims were time-barred. View "Lederer v. Schneider" on Justia Law

Plaintiff Robert Ferrante was involved in an automobile accident in 2006 where the other motorist caused the collision. Without informing his auto insurance carrier, defendant New Jersey Manufacturers Insurance Group (“NJM”), Ferrante initiated a negligence lawsuit against the tortfeasor, who had a liability limit of $100,000 on his insurance policy. The parties participated in mandatory arbitration, which set Ferrante’s damages at $90,000. Again, without informing NJM and allowing it to exercise its subrogation rights, Ferrante rejected the award, and sought a trial de novo. He also refused a $50,000 settlement offer without notifying NJM. Prior to the trial, Ferrante entered into a high-low agreement with the tortfeasor, which set the range of damages between $25,000 and $100,000, notwithstanding a jury verdict. Ferrante did not communicate this agreement or the trial itself to NJM, either. Following the trial, a jury awarded plaintiff $200,000 in damages, but the Law Division entered a judgment of $100,000 based on the high-low agreement. For the first time in 2011, Ferrante sent NJM a letter required by Longworth v. Van Houten, 223 N.J. Super. 174 (App. Div. 1988), stating that he was seeking UIM benefits. In the letter, Ferrante wrote that the other motorist was willing to settle for $100,000. However, Ferrante failed to mention the arbitration, high-low agreement, completed trial, or jury verdict. Based on this information, NJM told Ferrante to accept the offer. NJM and Ferrante proceeded to litigation over UIM coverage; only during a pretrial discovery exchange did Ferrante finally disclose his past dealings. NJM moved to dismiss the complaint, and the Law Division granted the motion, finding that Ferrante violated Longworth by not notifying NJM of any of the proceedings with the other motorist. On appeal, a split panel of the Appellate Division reversed. The majority held that because the trial court did not consider if NJM was actually prejudiced by the lack of notice, a remand was needed to determine if NJM sustained any prejudice. The New Jersey Supreme Court reversed: due to the complete absence of notice by Ferrante to NJM at any point over years of litigation, including the lack of notice about the high-low agreement or completed jury trial during the UIM process, NJM could refuse to pay the UIM benefits. View "Ferrante v. New Jersey Manufacturers Insurance Group" on Justia Law

Purnell hired Plaintiffs (Gabarette and Castillo) as independent contractors to deliver furniture in Virginia. Because it was a last-minute request, Plaintiffs did not have a vehicle available, so Purnell permitted them to use a truck that Purnell had rented from Penske. Driving to their destination, Plaintiffs stopped on the side of the interstate so Castillo could check on the security of the furniture load. Another driver struck the rented truck, killing Castillo and injuring Gabarette. Purnell’s motor vehicle insurance policy, issued by Wausau, included an uninsured/underinsured motorists (UIM) endorsement required by Virginia law, with coverage limited “to those autos shown as covered autos.” For UIM coverage—as opposed to liability coverage—the policy restricted coverage to “Owned Autos Only” and listed three vehicles on the “Schedule of Covered Autos You Own,” not including the rented Penske truck. The Declarations Pages provided that Wausau would “pay in accordance with the Virginia Uninsured Motorists Law, all sums the insured is legally entitled to recover as damages from the owner or operator of an uninsured motor vehicle.” For UIM purposes, an insured party is “[a]nyone . . . occupying a covered auto.” The UIM endorsement defines “covered auto” as “a motor vehicle, or a temporary substitute, with respect to which the bodily injury or property damage liability coverage of the policy applies.” The district court granted Wausau summary judgment regarding UIM coverage. The Fourth Circuit affirmed, based on the plain language of the policy. View "Levine v. Employers Insurance Co. of Wausau" on Justia Law

Edgar and Laurie Cook owned 200 acres of property in Bonner County, Idaho. The Property included Bloom Lake, a cabin, and a campground. The Cooks allowed people to use the lake and campground without charging a fee, but they solicited voluntary donations to help with the Property’s upkeep. Approximately twenty years ago, Michael Chisholm asked the Cooks if he could stay in the cabin in exchange for maintaining the Property. They agreed, and Chisholm began caring for the Property. In 2015, Joseph Stanczak and his girlfriend were camping at the Property. Chisholm invited them into the cabin, and a dispute later arose between Chisholm and Stanczak. Chisholm shot Stanczak twice with a .45 caliber handgun, then left the scene. Authorities later apprehended Chisholm and charged him with Aggravated Battery and Use of a Deadly Weapon in Commission of a Felony. Chisholm entered an Alford plea, by which he pleaded guilty without admitting guilt as to all the elements of the crimes. He was sentenced to prison. At issue in this was was the interpretation of the insuring clause of a bodily injury liability provision in a property insurance contract. The insurer, Farm Bureau Mutual Insurance Company of Idaho, determined it had no duty to defend or indemnify the Cooks because the shooting was not a covered act under the policy. Farm Bureau filed a declaratory judgment action seeking judicial confirmation of its determination. Farm Bureau then filed a motion for summary judgment, requesting that the district court find as a matter of law that the intentional shooting was not an “occurrence.” The district court granted Farm Bureau’s motion. Finding no reversible error in the district court's decision, the Idaho Supreme Court affirmed judgment in favor of Farm Bureau. View "Farm Bureau Ins v. Cook" on Justia Law

State Farm issued two policies of motor vehicle insurance to plaintiff, covering a Pontiac Grand Am and a Pontiac GTO. Each policy provided liability, uninsured motorist, and underinsured motorist coverage in the amounts of $100,000 per person and $300,000 per accident. Each contained a “Driver Exclusion Endorsement” that excluded Evans. Plaintiff was a passenger in a Hyundai automobile that was owned and operated by Evans when Evans’s vehicle was involved in an accident with another automobile. Evans was at fault. Plaintiff was injured and had more than $30,000 in medical bills. Evans’s insurer paid plaintiff $20,000, the policy limit. State Farm denied plaintiff's claim for underinsured motorist coverage. The circuit court granted plaintiff summary judgment. The appellate court and the Illinois Supreme Court affirmed, citing the Illinois Safety and Family Financial Responsibility Law (625 ILCS 5/7-601(a)), under which no one may operate a motor vehicle or allow a vehicle to be operated without obtaining sufficient insurance, and the Insurance Code (215 ILCS 5/143a, 143a-2), requiring automobile liability insurance policies to include uninsured and underinsured motorist coverage. The court reasoned that the named driver exclusion violated Illinois mandatory insurance requirements and public policy where the exclusion barred coverage for the named insured. View "Thounsavath v. State Farm Mutual Automobile Insurance Co." on Justia Law

State Farm issued two policies of motor vehicle insurance to plaintiff, covering a Pontiac Grand Am and a Pontiac GTO. Each policy provided liability, uninsured motorist, and underinsured motorist coverage in the amounts of $100,000 per person and $300,000 per accident. Each contained a “Driver Exclusion Endorsement” that excluded Evans. Plaintiff was a passenger in a Hyundai automobile that was owned and operated by Evans when Evans’s vehicle was involved in an accident with another automobile. Evans was at fault. Plaintiff was injured and had more than $30,000 in medical bills. Evans’s insurer paid plaintiff $20,000, the policy limit. State Farm denied plaintiff's claim for underinsured motorist coverage. The circuit court granted plaintiff summary judgment. The appellate court and the Illinois Supreme Court affirmed, citing the Illinois Safety and Family Financial Responsibility Law (625 ILCS 5/7-601(a)), under which no one may operate a motor vehicle or allow a vehicle to be operated without obtaining sufficient insurance, and the Insurance Code (215 ILCS 5/143a, 143a-2), requiring automobile liability insurance policies to include uninsured and underinsured motorist coverage. The court reasoned that the named driver exclusion violated Illinois mandatory insurance requirements and public policy where the exclusion barred coverage for the named insured. View "Thounsavath v. State Farm Mutual Automobile Insurance Co." on Justia Law